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Int J Cardiol . 2020 May 18;S0167-5273(20)32223-3. doi: 10.1016/j.ijcard.2020.05.036. Online ahead of print. Arrhythmic Profile and 24-hour QT Interval Variability in COVID-19 Patients Treated With Hydroxychloroquine and Azithromycin

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  • Int J Cardiol . 2020 May 18;S0167-5273(20)32223-3. doi: 10.1016/j.ijcard.2020.05.036. Online ahead of print. Arrhythmic Profile and 24-hour QT Interval Variability in COVID-19 Patients Treated With Hydroxychloroquine and Azithromycin


    Int J Cardiol


    . 2020 May 18;S0167-5273(20)32223-3.
    doi: 10.1016/j.ijcard.2020.05.036. Online ahead of print.
    Arrhythmic Profile and 24-hour QT Interval Variability in COVID-19 Patients Treated With Hydroxychloroquine and Azithromycin


    Alberto Cipriani 1 , Alessandro Zorzi 2 , Davide Ceccato 3 , Federico Capone 3 , Matteo Parolin 3 , Filippo Donato 2 , Paola Fioretto 3 , Raffaele Pesavento 3 , Lorenzo Previato 3 , Pietro Maffei 3 , Alois Saller 3 , Angelo Avogaro 3 , Cristiano Sarais 2 , Dario Gregori 2 , Sabino Iliceto 2 , Roberto Vettor 3



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    Abstract

    Background: Hydroxychloroquine and azithromycin combination therapy is often prescribed for coronavirus disease 2019 (COVID-19). Electrocardiographic (ECG) monitoring is warranted because both medications cause corrected QT-interval (QTc) prolongation. Whether QTc duration significantly varies during the day, potentially requiring multiple ECGs, remains to be established.
    Methods: We performed 12‑lead ECGs and 12‑lead 24-h Holter ECG monitoring in all patients aged <80 years admitted to our medical unit for COVID-19, in oral therapy with hydroxychloroquine (200 mg, twice daily) and azithromycin (500 mg, once daily) for at least 3 days. A group of healthy individuals matched for age and sex served as control.
    Results: Out of 126 patients, 22 (median age 64, 82% men) met the inclusion criteria. ECG after therapy showed longer QTc-interval than before therapy (450 vs 426 ms, p = .02). Four patients had a QTc ≥ 480 ms: they showed higher values of aspartate aminotransferase (52 vs 30 U/L, p = .03) and alanine aminotransferase (108 vs 33 U/L, p < .01) compared with those with QTc < 480 ms. At 24-h Holter ECG monitoring, 1 COVID-19 patient and no control had ≥1 run of non-sustained ventricular tachycardia (p = .4). No patients showed "R on T" premature ventricular beats. Analysis of 24-h QTc dynamics revealed that COVID-19 patients had higher QTc values than controls, with no significant hourly variability.
    Conclusion: Therapy with hydroxychloroquine and azithromycin prolongs QTc interval in patients with COVID-19, particularly in those with high levels of transaminases. Because QTc duration remains stable during the 24 h, multiple daily ECG are not recommendable.

    Keywords: COVID-19; Coronavirus; Severe acute respiratory syndrome; Sudden death; Ventricular arrhythmia.



    Copyright 2020. Published by Elsevier B.V.
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